Right ventricular myocardial infarction electrocardiogram

A right ventricular MI is a heart attack or cessation of blood flow to the heart muscle that involves the right side of the heart. A right sided lead ECG should be ordered and clearly labeled among any patient with ST elevation in the inferior leads (II, III and aVF). The diagnosis of right ventricular MI can be made using a right-sided electrocardiogram, on which ST-segment elevation in leads V3R and V4R will be seen.

• In addition to evidence of an acute inferior or inferoposterior myocardial infarction, the ECG may demonstrate ≥ 1 mm of doming ST elevation in the right sided precordial leads V4R to V6R.
• Right sided ST elevation, particularly in V4R, is indicative of acute right ventricular injury ^{[1] [2] [3]} and correlates closely with occlusion of the proximal right coronary artery.
• In one report of patients with acute inferior infarction, for example, ST elevation in V4R had 88 percent sensitivity and 78 percent specificity for concurrent right ventricular infarction. ^[4]
• Pulmonary embolism, pericarditis, and anteroseptal myocardial infarction also cause elevation of the ST segment in the right-sided precordial leads. As a result, an electrocardiographic diagnosis of right ventricular infarction cannot be made when one of these conditions is present. ^{[5] [6]}

Shown below is an EKG image featuring ST elevation at V4R depicting right ventricular myocardial infarction.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

Shown below is a 12 lead EKG image featuring ST elevation in II, III, aVF, V2, V3, V4 and V5 depicting inferior myocardial infarction and right ventricular myocardial infarction

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG image featuring right ventricular myocardial infarction. Note the ST elevation in lead V1 and high R/S ratio in V1.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:De-RV_MI.jpg

Shown below is an EKG featuring ST elevation in lead V1 depicting right ventricular myocardial infarction

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

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